The Great Influenza: The Story of the Deadliest Plague in History (originally subtitled The Epic Story of the Deadliest Pandemic in History) is a 2004 nonfiction book by John M. Barry that examines the Spanish flu, a 1918-1920 flu pandemic and one of the worst pandemics in history. Barry focuses on what was occurring in the United States at the time and attempts to place it against the background of American history and within the context of the history of medicine.[1] The book describes how the flu started in Haskell County, Kansas, USA, and spread to the U.S. Army training camp Camp Funston, Kansas, USA, and around the world through troop movements during World War I.
The 1918 influenza pandemic has been declared, according to Barry's text, as the 'deadliest plague in history'. The extensiveness of this declaration can be supported through the following statements: "the greatest medical holocaust in history"[2] and "the pandemic ranks with the plague of Justinian and the Black Death as one of the three most destructive human epidemics".[3] Although the origin site for the pandemic has been widely debated, Barry follows the research findings of epidemiologist Edwin O. Jordan to claim that the disease originated from Haskell County, Kansas and was spread to army camps, across the US and then to Europe.
Influenza epidemic poster from 1918 demonstrating the colloquial use of referring to the disease as 'Spanish' (i.e. the Spanish flu).
The influenza strain of the 1918 pandemic infected approximately 500 million people and during the First World War, this viral infection reported more deaths than military engagement.[4] Moreover, the disease caused the fatalities of more than 50 million people worldwide.[5] During the development of this disease, the influenza strain, colloquially, became known as the ‘Spanish flu’ due to the fact that Spain was the first country to publicly report on the disease.[6]
Content
Barry's book reviews details of the events preceding, during and following the 1918 influenza pandemic.
Part 1 of the text includes accounts of various scientists and intellectuals throughout history, and describes their theories, and methodologies. He identifies and critiques the progression of science throughout history and the evolution of medicine to be performed as a science-based occupation.[7] Specifically, the first part of Barry's text contextualises the US medical field in comparison to Europe, highlighting the inhibitors of progress in the US. Barry introduces William H. Welch as a key influential figure in US medicine due to him being an acclaimed ‘inspiration’ to many graduates from The Johns Hopkins University School of Medicine who went on to make vital discoveries in science. Moreover, this part of the text details the lack of advancement of other US medical schools compared to the Hopkins institution due to the Flexner Report that was introduced in 1919, specifically that 80% of medical schools were categorised as ‘poor quality’ and in need of closing. Moreover, Barry discusses Welch founding the Johns Hopkins Bloomberg School of Public Health in 1916, in which Welch was the first Dean.
Johns Hopkins Hospital, early photo
Part 2 of the text identifies Haskell County, Kansas to be the origin site of the influenza strain based on epidemiological evidence derived from a local doctor to the site, Loring Miner and details the distribution across the US through army camps. Furthermore, Barry addresses the difficulty of explaining the origin of viruses, even in modern-day science and references this as an ‘enigma’. He defines what a virus is, specifically their function and the process of replication of viruses to produce iterations of original virus. Also, Barry narrates Influenza A virus subtype H1N1 originating from wild birds and discusses how the structure of the virus makes it suitable for attacking respiratory systems, hence also the reasoning for its rapid spread from host to host. Barry goes through the function of the immune system in recognising and fighting viruses, as well as the presence of mutations to impede the immune system's functionality.
Part 3 of the text examines the potential reasonings the US joined the First World War and their preparatory process, including creating a National Research Council (United States) that incorporated scientifically qualified men identified in the first part of the text to prevent this influenza spread. This council was created after an outbreak of measles spread severely within the US army troops and majority of the cases leading to pneumonia. Although a vaccine for pneumonia was eventually developed, a board was created for its specific consideration within the army. Barry discusses the shortage of medical professionals among civilians and President Woodrow Wilson’s drastic measures, to gather troops for the First World War, as key factors for the spread of the 1918 influenza virus.
Part 4, 5 and 6 of the text discusses the casualties due to the pandemic specifically in the second half of 1918, as well as comparing the first and second wave statistics. These parts include different forms of evidence that portray accounts of the public’s fear and uncertainty of the pandemic and the contributing influences to these emotions, specifically the misinformation or lack of information distributed by the media during this time period.
Graves of 100 American wounded soldiers at Paignton Military Hospital, Devon, England, that died from the epidemic of influenza.
Part 7 of the text details the accounts of scientists and their attempts to generate an effective vaccine to prevent the spread of the influenza strain. Barry narrates that the scientists at the time were tasked to understand the epidemiology of the influenza virus and identify the pathogen that was causing this disease. Although, the disease was identified as airborne, scientists were not successful in enforcing social distancing or lockdown to prevent the viral spread. Moreover, due to the inability to control this pandemic, Barry narrates that scientists rushed their methodology and processes of identifying the pathogen causing the virus. Most scientists followed the assumption that the causing pathogen was B influenzae. However, Barry states that when Welch has the virus, the scientist Oswald Avery maintained scientifical protocol and process of experiment in the hopes of identifying the correct pathogen that was causing this virus.
Part 8 and 9 describes the conclusion of the pandemic, specifically detailing the scientific realisations, viral mutations and emotional aftermath caused by the pandemic. Barry narrates President Wilson’s unwillingness to follow scientists’ warnings and continued to send men to war which ultimately increased the spread of influenza in the tightly packed ships. Barry reports that the public health system was overwhelmed and that the only way the influenza outbreak could be mitigated was through quarantines, however they were not established by authority. Parts 8 and 9 outline the desperation of citizens to relieve symptoms and addresses individual concoctions to heal and untested vaccines being used, despite the knowledge that isolation was the only valid method of prevention of viral distribution. Barry details the consequence of numerous orphans due to the virus targeting young adults, as well as the public opinion distrusting their leaders and science.
1918 Headlines from Chicago newspapers demonstrating the heightened focus on details of the pandemic in the media.
Finally, the last part of the text follows scientist Oswald Avery's continual researching of the pneumonia pathogen subsequent to the pandemic, and details his findings.[8] Avery spent over a decade researching this and Barry states that his findings revolutionised the world of biology as he was the first scientist to prove that DNA carries genetic information. Barry concludes his narration of the events of the 1918 influenza pandemic with reference to scientists, Paul A. Lewis and Richard Shope, finally detecting the pathogen responsible for the pandemic, however not until 1931.[9]
Point of dispute: geographical origins
The geographical origins of the 1918 influenza virus is a familiar point of contention due to the various evidence-based claims. Although the origin site for the pandemic has been widely debated, Barry follows the research findings of epidemiologist Edwin O. Jordan to claim that the disease originated from Haskell County, Kansas and was spread to army camps, across the US and then to Europe.[10] Nevertheless, the general consensus is more indistinct than Barry's claim; the acknowledgement being that the disease originated from the Midwest of the United States of America.[11]
The location in which the H1N1 influenza A virus originated is a point of contention and has been acknowledged to be in China, the United States of America or Europe. Olson and colleagues critique the widely held viewpoint that the virus emerged from Kansas, USA; stating that this dominant belief “has become widely accepted without rigorous re-evaluation of the original evidence”.[12] They suggest the idea of the virus originating in Europe and spreading to New York due to troop movements in the First World War. Moreover, this idea was initiated in 1919 by Dr William Hallock Park, a bacteriologist and the director of the New York City Health Department, in which he states that “observations in France and England indicated a filterable virus was present in at least one of the cases”.[13] Moreover, it has been suggested by Langford that there might have been a mild outbreak of influenza in 1917 that travelled to England and France “via the personnel of the Chinese Labour Corps, then mutated to a more virulent form when the Chinese workers returned home in 1918”.[14] However, this suggestion cannot be confirmed due to bacteriological and clinical data being too insubstantial and irregular.[15]
Barry's theory regarding the geographical site of origin for the 1918 influenza virus is also problematic due to the ‘herald wave’ that was evident during the beginning months of 1918 in not only New York, USA, but also in military camps throughout Norway during the same time period.[16] Although Barry's discussion of the virus first emerging in Kansas, USA is widely accepted, it is evident that it is a point of contention in the word of science.
Textual comparison
John M. Barry, author of The Great Influenza, has been considered alongside Alfred W. Crosby, author of the America’s Forgotten Pandemic to have done ‘ground breaking’ historiographical work on the 1918 influenza pandemic.[17] Crosby's text, first published in 1976, is considered a dominant historical text unpacking the events of the 1918 influenza virus and significantly discusses the significant presence of the First World War to ‘shadow’ details of the pandemic into obscurity.[18] This is relevant as Barry's text was originally published in 2004, 28 years after Crosby's America’s Forgotten Pandemic. Hence, although it has been stated that Barry ‘echoes’ Crosby's historical research in The Great Influenza, he has a stronger emphasis on the biology. Also, Barry's had the opportunity to collate 28 years of further research and commentary to better inform his text's historical, and biological narrative of the 1918 influenza.
Reviews
Stephen C. Schoenbaum comments on John Barry's non-fiction text through his 2004 review by critically stating that the text "includes lots of interesting tidbits, some relevant, some not, some accurate, and some not".[19] Furthermore, Schoenbaum identifies 'telling stories' as a strong component of the text, however its historical overview should not be considered 'definitive'. Nevertheless, Barry's text is declared as a "rewarding experience" with other scholarly authors not presenting the "same combination of interests as Mr Barry".[20]
Andrew Noymer recognises the broad audience regarding accessibility of Barry's non-fiction text and its focus on specific historical, and medical matters. This is evident through his statement, "… the book is written for a general audience as well as for academic experts".[21] Moreover, Noymer indicates the questionable reliability of Barry's anecdotes as "not all anecdotes… [were] documented by sources in the endnotes".[22] Hence, suggesting there to be an issue when evaluating the book as "a piece of historical research"[22]
Joseph Topinka, Daniel Molnar, Brandon Gardner and Rosemary Wosky extensively evaluate the quality of John Barry's text The Great Influenza: The Epic Story of the Deadliest Plague in History in their 2015 review. The review recognises the historical framework Barry provides for understanding the social environment, as well as the political issues of the influenza pandemic. The review declares "Barry's description of the spreading of the influenza and the reaction to it by the local and national governments all provide lessons from which we can learn".[23] Hence, Topinka et al. indicate their perspective of the didactic nature of the text, specifically regarding decision-making or lack thereof, as well as advocation for public education and alteration of legal frameworks under public health law. They agree with Barry's discussion of the historical spread of this disease, specifically that "we must learn from the influenza pandemic of 1918".[24]
A 2004 Journal of Clinical Investigation review said that the book was "well conceived, well researched, and extremely well written" targeting a broad audience—physicians, scientists, medical students, and history buffs.[1] Barry Gewen of The New York Times praised it saying "He is a good teacher, in part because he assumes that his readers don't know anything. He explains the technical stuff clearly, with nice, homey analogies".[25]
Reaction
In the summer of 2005, then-President George W. Bush read the book while on vacation at his ranch in Crawford.[26] His study would later set forth plans for the federal government to prepare for future pandemics in a November 2005 speech.[27]
In 2020, the book experienced a surge in popularity as a result of the COVID-19 pandemic.[28]
Related Research Articles
A pandemic is an epidemic of an infectious disease that has a sudden increase in cases and spreads across a large region, for instance multiple continents or worldwide, affecting a substantial number of individuals. Widespread endemic diseases with a stable number of infected individuals such as recurrences of seasonal influenza are generally excluded as they occur simultaneously in large regions of the globe rather than being spread worldwide.
A zoonosis or zoonotic disease is an infectious disease of humans caused by a pathogen that can jump from a non-human to a human and vice versa.
An epidemic is the rapid spread of disease to a large number of hosts in a given population within a short period of time. For example, in meningococcal infections, an attack rate in excess of 15 cases per 100,000 people for two consecutive weeks is considered an epidemic.
The 1918–1920 flu pandemic, also known as the Great Influenza epidemic or by the common misnomer Spanish flu, was an exceptionally deadly global influenza pandemic caused by the H1N1 subtype of the influenza A virus. The earliest documented case was March 1918 in the state of Kansas in the United States, with further cases recorded in France, Germany and the United Kingdom in April. Two years later, nearly a third of the global population, or an estimated 500 million people, had been infected in four successive waves. Estimates of deaths range from 17 million to 50 million, and possibly as high as 100 million, making it one of the deadliest pandemics in history.
Influenza A virus (IAV) is the only species of the genus Alphainfluenzavirus of the virus family Orthomyxoviridae. It is a pathogen with strains that infect birds and some mammals, as well as causing seasonal flu in humans. Mammals in which different strains of IAV circulate with sustained transmission are bats, pigs, horses and dogs; other mammals can occasionally become infected.
Antigenic shift is the process by which two or more different strains of a virus, or strains of two or more different viruses, combine to form a new subtype having a mixture of the surface antigens of the two or more original strains. The term is often applied specifically to influenza, as that is the best-known example, but the process is also known to occur with other viruses, such as visna virus in sheep. Antigenic shift is a specific case of reassortment or viral shift that confers a phenotypic change.
Reassortment is the mixing of the genetic material of a species into new combinations in different individuals. Several different processes contribute to reassortment, including assortment of chromosomes, and chromosomal crossover. It is particularly used when two similar viruses that are infecting the same cell exchange genetic material. In particular, reassortment occurs among influenza viruses, whose genomes consist of eight distinct segments of RNA. These segments act like mini-chromosomes, and each time a flu virus is assembled, it requires one copy of each segment.
Swine influenza is an infection caused by any of several types of swine influenza viruses. Swine influenza virus (SIV) or swine-origin influenza virus (S-OIV) refers to any strain of the influenza family of viruses that is endemic in pigs. As of 2009, identified SIV strains include influenza C and the subtypes of influenza A known as H1N1, H1N2, H2N1, H3N1, H3N2, and H2N3.
Influenza A virus subtype H1N1 (A/H1N1) is a subtype of influenza A virus (IAV). Some human-adapted strains of H1N1 are endemic in humans and are one cause of seasonal influenza (flu). Other strains of H1N1 are endemic in pigs and in birds. Subtypes of IAV are defined by the combination of the antigenic H and N proteins in the viral envelope; for example, "H1N1" designates an IAV subtype that has a type-1 hemagglutinin (H) protein and a type-1 neuraminidase (N) protein.
An influenza pandemic is an epidemic of an influenza virus that spreads across a large region and infects a large proportion of the population. There have been six major influenza epidemics in the last 140 years, with the 1918 flu pandemic being the most severe; this is estimated to have been responsible for the deaths of 50–100 million people. The 2009 swine flu pandemic resulted in under 300,000 deaths and is considered relatively mild. These pandemics occur irregularly.
Influenza A virus subtype H2N2 (A/H2N2) is a subtype of Influenza A virus. H2N2 has mutated into various strains including the "Asian flu" strain, H3N2, and various strains found in birds. It is also suspected of causing a human pandemic in 1889. The geographic spreading of the 1889 Russian flu has been studied and published.
An emerging infectious disease (EID) is an infectious disease whose incidence has increased recently, and could increase in the near future. The minority that are capable of developing efficient transmission between humans can become major public and global concerns as potential causes of epidemics or pandemics. Their many impacts can be economic and societal, as well as clinical. EIDs have been increasing steadily since at least 1940.
Spanish flu research concerns studies regarding the causes and characteristics of the Spanish flu, a variety of influenza that in 1918 was responsible for the worst influenza pandemic in modern history. Many theories about the origins and progress of the Spanish flu persisted in the literature, but it was not until 2005, when various samples of lung tissue were recovered from American World War I soldiers and from an Inupiat woman buried in permafrost in a mass grave in Brevig Mission, Alaska, that significant genetic research was made possible.
The pandemic H1N1/09 virus is a swine origin influenza A virus subtype H1N1 strain that was responsible for the 2009 swine flu pandemic. This strain is often called swine flu by the public media due to the prevailing belief that it originated in pigs. The virus is believed to have originated around September 2008 in central Mexico.
The social history of viruses describes the influence of viruses and viral infections on human history. Epidemics caused by viruses began when human behaviour changed during the Neolithic period, around 12,000 years ago, when humans developed more densely populated agricultural communities. This allowed viruses to spread rapidly and subsequently to become endemic. Viruses of plants and livestock also increased, and as humans became dependent on agriculture and farming, diseases such as potyviruses of potatoes and rinderpest of cattle had devastating consequences.
The 1889–1890 pandemic, often referred to as the "Asiatic flu" or "Russian flu", was a worldwide respiratory viral pandemic. It was the last great pandemic of the 19th century, and is among the deadliest pandemics in history. The pandemic killed about 1 million people out of a world population of about 1.5 billion. The most reported effects of the pandemic took place from October 1889 to December 1890, with recurrences in March to June 1891, November 1891 to June 1892, the northern winter of 1893–1894, and early 1895.
This is a timeline of influenza, briefly describing major events such as outbreaks, epidemics, pandemics, discoveries and developments of vaccines. In addition to specific year/period-related events, there is the seasonal flu that kills between 250,000 and 500,000 people every year and has claimed between 340 million and 1 billion human lives throughout history.
Human-to-human transmission (HHT) is an epidemiologic vector, especially in case the disease is borne by individuals known as superspreaders. In these cases, the basic reproduction number of the virus, which is the average number of additional people that a single case will infect without any preventative measures, can be as high as 203.9. Interhuman transmission is a synonym for HHT.
The 1977 Russian flu was an influenza pandemic that was first reported by the Soviet Union in 1977 and lasted until 1979. The outbreak in northern China started in May 1977, slightly earlier than that in the Soviet Union. The pandemic mostly affected a population younger than 25 or 26 years of age, and was described as mild. It was caused by an H1N1 flu strain which highly resembled a virus strain circulating worldwide from 1946 to 1957. Genetic analysis and several unusual characteristics of the 1977 Russian flu have prompted many researchers to say that the virus was released to the public through a laboratory accident, or resulted from a live-vaccine trial escape.
↑ Waring, J. I. (1971). "A History of Medicine in South Carolina 1900–70". South Carolina Medical Association: 33.
↑ Starr, I (1976). "Influenza in 1918: recollections of the epidemic in Philadelphia". Annals of Internal Medicine. 85 (4): 516–518. doi:10.7326/0003-4819-85-4-516. PMID788585.
↑ Chobra, Terence; Breedlove, Byron (2018). "Concurrent Conflicts—the Great War and the 1918 Influenza Pandemic". Emerging Infectious Diseases. 24 (10): 1968.
↑ Summary of John M. Barry's The Great Influenza (Audiobook). Falcon Press. 2021.
↑ Humphries, M. O. (2014). "Paths of Infection: The First World War and the Origins of the 1918 Influenza Pandemic". War in History. 21: 61–62. doi:10.1177/0968344513504525. S2CID159563767.
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